Today, I was invited to do something because I’ve been identified as “an expert in emergency mental health care.” I did wonder whether this was one of those mistakes made by someone who wasn’t reading closely enough, as when a medical recruitment company recently invited me apply for “vacant consultant psychiatrists’ positions in Birmingham, Manchester or London”. Apparently my CV had impressed them – my LinkedIn page, actually. It was obviously somehow beyond-impressive as it managed to distract their attention away from my utter lack of a medical degree or any professional registration as a medical practitioner. In fairness, I do have a first-aid certificate … but actually, even that’s expired if I’m being completely honest because I’m not currently in an operational role. I’m an associate member of the College of Paramedics, if that helps, but in fairness they don’t let me anywhere near the drugs or the cannulas. So nothing makes me an expert in emergency mental health care … I’m a policeman.
I can probably claim to have read certain medical or clinical guidelines from NICE and various Royal Colleges like Psychiatrists or Emergency Medicine that some doctors and nurses haven’t read (or heard of), but I’ll admit there were some large words in there based on Greek and Latin and I didn’t entirely understand them – I certainly couldn’t try to spell them in order to make this post look more impressive. So no, I don’t feel like an expert in anything, quite honestly. Me and my 4hrs of training (half of it was wrong, the other half was irrelevant in the real world) are still making this stuff up as I go along – sometimes literally. I’m trying to do that conscientiously, of course, and I want to understand things and make progress but nevertheless, that’s what this all amounts to – improvising. Most of this blog, is just me trying to put thoughts in order so it sounds vaguely coherent by the time I have to talk about it in meetings.
MENTAL HEALTH LAW
I realised early on that one key perspective missing from this emergency mental health care stuff, is the legal one and as a police officer, I can do something about that. Whilst I’m not legally qualified, I’ve done my legal exams for promotions and am used to making operational policing decisions based on my understanding of criminal and other laws. As a lot of the things I’ve been asked do to in my operational service and in policy work on mental health have been to consider the implementation of police powers or support for the administration of the Mental Health Act. It has always been true the majority of questions raised when I was the force MH lead for West Midlands Police and since being at the College of Policing these last three years were legal questions. “Have I got power to force entry?” … “Can I not rely on the Mental Capacity Act to do that?” and my favourite one, “Can English police detain an eastern European man who is missing from a CTO under Scottish mental health law if we found him near the wheelie bins behind Marks and Spencer’s in Nottingham?!” … err, just use s136, officer!
Even in my attempts to bring that perspective nearer the front of the considerations about how the police interface with health services of all kinds, I’m all too conscious that I have no qualified expertise. I was especially conscious of this when I spent several recent hours in the witness box of a Coroner’s Court … seven barristers lined up, none of them on my ‘side’ because I was an independent witness to the Court. I stood there before the questions started, just thinking to myself “this is where I’m probably going to be badly exposed” – for making it up and misunderstanding things! What I’ve noticed over the years is that when police officers ask police in-house lawyers for legal advice on mental health law, they often direct officers to me, so how solid our legal advice is, I’m not entirely sure! I even once raised a question with an in-house lawyer and he sent me a link to my own BLOG … you couldn’t make it up!
So it was with some relief to find that the only really challenging legal questions in court about the police guidance produced by the College of Policing in 2016 came from one barrister who merely insisted that we, the College, were wrong about how to interpret the some of the stated cases relevant to the issues before the jury; and wrong about whether the Mental Capacity Act could be relied upon to take someone from their own home to an Emergency Department. In fact, “precisely wrong” was the phrase used to describe it … I could only escape by insisting that we’d taken great care in producing this stuff, listened to many professional and individual perspectives from all over the place, including AMHPs, solicitors and other professionals who train the MCA to care staff and, of course, the we’d taken legal advice on it all. If I’m wrong, I’m wrong with a lot of people stood metaphorically behind me, helping me get this wrong.
A friend of mine recently posted a meme on Facebook, “The older I get the more I realise no one has a ******* clue what they’re doing. Everyone’s just winging it.” Be honest with yourself and disagree if you need to … but I certainly am and I couldn’t help but notice that whilst she was telling me I was wrong, she wasn’t telling me why I was wrong … and I’m still none the wiser today. Maybe she was making it up as she went along?! … it’s easy to accuse an unqualified policeman of talking rubbish without explaining yourself and then just move on to the next question after hearing his answer.
I’ve worried for some time about police officers crossing the floor with mental health matters because they perceive themselves as gaining in expertise when they’re working so closely with their partners in NHS mental health services. And just to show I’m not the only one thinking about this sort of thing, I’ve had a few conversation with Claire Andre, the police liaison nurse at Northumberland, Tyne and Wear mental health NHS trust. She’s been asked if she’s actually a police officer and has had to explain she’s a nurse, just as I’ve been asked if I was a mental health nurse before joining the police – she like me, couldn’t work out whether to be flattered, offended or both! But we’re both alive to the idea the idea that police officers and nurses working closely at this interface can end up thinking of themselves as some kind of hybrid professional, rather than just a better informed cop, or nurse.
This kind of thing reached peak nightmare for my version of this concern when I happened to walk in to a street triage office somewhere in England last year to overhear one of the PCs on the telephone to a person I had to assume was a member of the public who’d rung the police in connection with MH issues. As I entered the room I heard, “Yeah, uh huh … you probably need to up your meds!” in an encouraging voice.
Turns out it was a known mental health patient who’d rung the CrisisTeam and been told to ring the police, but presumably not to get medication advice from an officer?! … we need to get a grip! What if that person now takes more than they were prescribed to take, already on a high dosage or are self-medicating, using other substances and they end up developing serotonin syndrome?! That sort of thing can prove fatal if properly qualified people aren’t advising patients what to put in to their bodies and you should alter medication only under clinical guidance or supervision, for various reasons …. and all because some PC over-reached their expertise, if they actually had any to start with. And just to back up the very point I’m making here about my lack of expertise in these matters, I can only protest about the consequences of ill-advised police advice about SSRIs because I asked a couple of clinically qualified people, including Claire how to construct this paragraph! Why would I know, beyond me knowing it’s a BAD THING?! … I’m a policeman.
STRIKING A BALANCE
You have to work for three years at university to qualify as a mental health nurse so what chance we can pick this stuff up in police car by doing a few shifts with street triage?! … whilst there’s no university course for policing, you take prosecution decisions in the police at the rank of sergeant, so it usually takes even longer than an undergraduate degree and involves those legal examinations I mentioned earlier, in addition to years of experience of investigating crime, preparing court evidence and handling custody detainees. So this stuff works both ways round: I’ve had numerous MH care professionals telling me what they think the law is only to get it so badly wrong that it was genuinely difficult not to laugh and just pat them on the head. My point is: nurses nurse, the police police – we just have to learn how to better manage that interface without being unable to ask questions or even challenge on occasion. But we hven’t go this balance right yet and we must put the public and vulnerable people first in all that we do.
So, some kind of mental health expert? … no. And this isn’t faux modesty or an attempt to be humble: it’s actually a real insistence that you’ve very badly understood what I’m trying to do here! I’m not trying to fix the world, I’m trying to police it and that means ensuring rights and protections for vulnerable people as well as taking the most difficult decision of all: when those responsibilities mean I should use force on a vulnerable people to protect them and when, if at all, I should place them even further in to the criminal justice system than their contact with me.
That isn’t mental health care: it’s policing.
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